Chapter 47: Management of Patients With Intestinal and Rectal Disorders
Which of the following is accurate regarding regional enteritis? 1. Severe diarrhea 2. Severe bleeding 3. Fistulas are common 4. Exacerbations and remissions
4. Exacerbations and remissions The course of regional enteritis is prolonged and variable. There is mild bleeding, fistulas are rare, and diarrhea is less severe than ulcerative colitis.
The nurse caring for a client with diverticulitis is preparing to administer the client's medications. The nurse anticipates administration of which category of medication because of the client's diverticulitis? 1. Antispasmodic 2. Anti-inflammatory 3. Antianxiety 4. Antiemetic
1. Antispasmodic The nurse anticipates administration of antispasmodic medication to decrease intestinal spasm associated with diverticulitis. The client may also be ordered an opioid analgesic to relieve the associated pain. There is no indication that the client needs antianxiety, antiemetic, or anti-inflammatory medications at this time.
Crohn's disease is a condition of malabsorption caused by which pathophysiological process? 1. Inflammation of all layers of intestinal mucosa 2. Infectious disease 3. Gastric resection 4. Disaccharidase deficiency
1. Inflammation of all layers of intestinal mucosa Crohn's disease, also known as regional enteritis, can occur anywhere along the gastrointestinal tract but most commonly at the distal ileum and in the colon. Infectious disease causes problems such as small-bowel bacterial overgrowth, leading to malabsorption. Disaccharidase deficiency leads to lactose intolerance. Postoperative malabsorption occurs after gastric or intestinal resection.
A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? 1. Suggest fluid intake of at least 2 L/day 2. Instruct the client to avoid prune or apple juice 3. Assist the client regarding the correct diet or to minimize food intake 4. Instruct the client to keep a record of food intake
1. Suggest fluid intake of at least 2 L/day The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract.
A client has developed an anorectal abscess. Which client is at most risk for the development of this type of abscess? 1. A client with hemorrhoids 2. A client with Crohn's disease 3. A client with diverticulosis 4, A client with colon cancer
2. A client with Crohn's disease An anorectal abscess is common in clients with Crohn's disease. The other disorders do not predispose the client to risk for anorectal abscess.
Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following? 1. Calorie restriction 2. Low protein 3. Iron restriction 4. Low residue
4. Low residue Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.
A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? 1. "I don't like oatmeal, so it doesn't matter that I can't have it." 2. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 3. "I don't understand this; I took the medication the doctor ordered and followed the diet." 4. "I don't understand why this happened again; I didn't travel out of the country."
2. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.
Which statement provides accurate information regarding cancer of the colon and rectum? 1. Rectal cancer affects more than twice as many people as colon cancer. 2. Colorectal cancer is the third most common site of cancer in the United States. 3. Colon cancer has no hereditary component. 4. The incidence of colon and rectal cancer decreases with age.
2. Colorectal cancer is the third most common site of cancer in the United States. Cancer of the colon and rectum is the third most common site of new cancer cases in the United States. Colon cancer affects more than twice as many people as does rectal cancer (94,700 for colon, 34,700 for rectum). The incidence increases with age (the incidence is highest in people older than 85). Colon cancer occurrence is higher in people with a family history of colon cancer.
The nurse is talking with a group of clients who are older than age 50 years about the recognition of colon cancer to access early intervention. What should the nurse inform the clients to report immediately to their primary care provider? 1. Abdominal cramping when having a bowel movement 2. Daily bowel movements 3. Excess gas 4. Change in bowel habits
4. Change in bowel habits The chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Excess gas, daily bowel movements, and abdominal cramping when having a bowel movement are not indicators of colon cancer.
The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation? 1. Current medications 2. Activity levels 3. Alcohol consumption 4. Usual pattern of elimination
4. Usual pattern of elimination Constipation has many possible reasons and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.
Diarrhea
an increased frequency of bowel movements or an increased amount of stool with altered consistency (i.e., increased liquidity) of stool.
Fistula
anatomically abnormal tract that arises between two internal organs or between an internal organ and the body surface
Irritable Bowel Syndrome (IBS)
chronic functional disorder characterized by recurrent abdominal pain that affects frequency of defecation and consistency of stool; is associated with no specific structural or biochemical alterations
Constipation
fewer than three bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass
Malabsorption
Impaired transport across the mucosa
Peritonitis
Inflammation of the lining of the abdominal cavity
Fecal Incontinence
Involuntary passage of feces
Fissure
Normal or abnormal fold, groove, or crack in the body tissue
Inflammatory Bowel Disease (IBD)
group of chronic disorders (ulcerative colitis and Crohn's disease) that result in inflammation or ulceration (or both) of the bowel lining
Tenesmus
ineffective and sometimes painful straining and urge to eliminate either feces or urine
Diverticulitis
inflammation of a diverticulum from obstruction by fecal matter resulting in abscess formation
abscess
localized collection of purulent material surrounded by inflamed tissues
Gastrocolic Reflex
peristaltic movements of the large bowel occurring five to six times daily that are triggered by distention of the stomach
Diverticulosis
presence of several diverticula in the intestine
Diverticulum
saclike out-pouching of the lining of the bowel protruding through the muscle of the intestinal wall
Hemorrhoids
Dilated portions of the anal veins
A nurse is teaching an older adult client about good bowel habits. Which statement by the client indicates to the nurse that additional teaching is required? 1. "I need to use laxatives regularly to prevent constipation." 2. "I need to drink 2 to 3 liters of fluids every day." 3. "I should exercise four times per week." 4. "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread."
1. "I need to use laxatives regularly to prevent constipation." The client requires more teaching if he states that he'll use laxatives regularly to prevent constipation. The nurse should teach this client to gradually eliminate the use of laxatives because using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health.
A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet. 1. Salami on whole grain bread and V-8 juice 2. A peanut butter sandwich and fruit cup 3. Broiled chicken with low-fiber pasta 4. A fruit salad with yogurt
3. Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.
Steatorrhea
Excess of fatty wastes in the feces
Colostomy
surgical opening into the colon by means of a stoma to allow drainage of bowel contents; one type of fecal diversion
Ileostomy
surgical opening into the ileum by means of a stoma to allow drainage of bowel contents; one type of fecal diversion
In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important? 1. Limiting fluid intake to 5 to 6 glasses per day 2. Adding fiber-rich foods to the diet gradually 3. Minimizing activity levels for at least 2 months 4. Avoiding bran cereals and beans in the diet
2. Adding fiber-rich foods to the diet gradually The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.
The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes? 1. Tenesmus 2. Borborygmus 3. Loud bowel sounds 4. Peristalsis
2. Borborygmus Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.
A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder? 1. Blood and mucus in the stool 2. Chronic constipation with sporadic bouts of diarrhea 3. Weight loss due to malabsorption 4. Client is awakened from sleep due to abdominal pain.
2. Chronic constipation with sporadic bouts of diarrhea Most clients with irritable bowel syndrome (IBS) describe having chronic constipation with sporadic bouts of diarrhea. Some report the opposite pattern, although less commonly. Most clients experience various degrees of abdominal pain that defecation may relieve. Weight usually remains stable, indicating that when diarrhea occurs, malabsorption of nutrients does not accompany it. Stools may have mucus, but blood is not usually found because the bowel is not locally inflamed. The sleep is not disturbed from abdominal pain.
The nurse is conducting discharge teaching for a client with diverticulosis. Which instruction should the nurse include in the teaching? 1. Use laxatives weekly. 2. Drink 8 to 10 glasses of fluid daily. 3. Avoid daily exercise. 4. Avoid unprocessed bran.
2. Drink 8 to 10 glasses of fluid daily. The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.
The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening? 1. History of skin cancer 2. Familial polyposis 3. Low-fat, low-protein, high-fiber diet 4. Age younger than 40 years
2. Familial polyposis Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years andd a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.
A client is admitted to the hospital for diagnostic testing to rule out colorectal cancer. Which intervention should the nurse include on the plan of care? 1. Prepare the client for a gastrostomy tube placement. 2. Test all stools for occult blood. 3.Administer morphine (Duramorph PF) routinely, as ordered. 4, Administer topical ointment to the rectal area to decrease bleeding.
2. Test all stools for occult blood. Blood in the stools is one of the warning signs of colorectal cancer. The nurse should plan on checking all stools for both frank and occult blood. The blood in the stool is coming from the colon or rectum; administering an ointment wouldn't help decrease the bleeding. Preparing a client for a gastrostomy tube isn't appropriate when diagnosing colorectal cancer. Colorectal cancer is usually painless; administering opioid pain medication isn't needed
Which client requires immediate nursing intervention? The client who: 1. presents with ribbonlike stools. 2. presents with a rigid, boardlike abdomen. 3. complains of epigastric pain after eating. 4. complains of anorexia and periumbilical pain.
2. presents with a rigid, boardlike abdomen. A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbonlike stools.
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find: 1. tenderness and pain in the right upper abdominal quadrant. 2. severe abdominal pain with direct palpation or rebound tenderness. 3. jaundice and vomiting. 4. rectal bleeding and a change in bowel habits.
2. severe abdominal pain with direct palpation or rebound tenderness. Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.
An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"? 1. one bowel movement daily 2. stool consistency and client comfort 3. two bowel movements daily 4. one bowel movement every other day
2. stool consistency and client comfort Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.
Which term refers to intestinal rumbling? 1. Tenesmus 2. Diverticulitis 3. Borborygmus 4. Azotorrhea
3. Borborygmus Borborygmus is the intestinal rumbling caused by gas moving through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining upon evacuation of stool. Azotorrhea refers to excess nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter), resulting in abscess formation.
The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? 1. Normal erythrocyte sedimentation rate (ESR) 2. Subnormal temperature 3. Hypotension 4. Bradycardia
3. Hypotension Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.
A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time? 1. Constipation 2. Paralytic ileus 3. Peritonitis 4. Accumulation of gas
3. Peritonitis Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.
The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? 1. Dust with nystatin powder 2. Apply barrier powder 3. Apply triamcinolone acetonide spray 4. Dry skin thoroughly after washing
4. Dry skin thoroughly after washing The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.
A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a: 1. hemorrhoid. 2. fistula. 3. pilonidal cyst. 4. fissure.
4. fissure. An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.
A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation? 1. lack of solid food 2. lack of exercise 3. increased fiber 4. lack of free water intake
4. lack of free water intake A client who cannot swallow food cannot drink enough water to meet daily needs. Inadequate fluid intake is a common cause of constipation.